CAESAREAN SECTION

history, development and clinical

implication
Gulardi H. Wiknjosastro
Bagian Obstetri Ginekologi
FKUI RS Dr. Cipto Mangunkusumo
Jakarta
History
Caesarean
Mitos : J. caesar
dilahirkan dari ibu
Aeralius
The extraction of Asclepius from the
abdomen of his mother Coronis by his
father Apollo. Woodcut from the 1549
edition of Alessandro Beneditti's De Re
Medica.
History
J. Caesar melakukan
invasi ke Inggeris, Ibu
merestuinya
One of the earliest printed illustrations of
Cesarean section. Purportedly the birth of
Julius Caesar. A live infant being surgically
removed from a dead woman. From
Suetonius' Lives of the Twelve Caesars, 1506
woodcut.
Developing country
Seksio dilakukan
pada ibu yang
sekarat/meninggal
Successful Cesarean section performed by
indigenous healers in Kahura, Uganda. As
observed by R. W. Felkin in 1879.
Embriotomi
Craniotomy. Perforation of the skull,
removal of cranial contents, and
extraction of the collapsed skull.
Fetal malformation
< 28 week pregnancy
DIC
Philosophy : The procedure
should be on scientific base , for
the sake/benefit of the patient
and with least burden.
Risk

Risk of maternal death due to
CS

Trend of rising CS rate
Belanda dengan
angka seksio yang
rendah mempunyai
angka kematian ibu
dan perinatal yang
rendah di dunia
Dikutip dari: E.J . Quilligan, 2001
Dikutip dari: E.J . Quilligan, 2001
Indication of CS by country

Dystocia
Placenta previa & abruptio
Fetal distress
Shoulder pres.
Prev. CS
Breech
Triplets++

Indikator plasenta
previa
USG pada kehamilan
> 37 mgg
Dikutip dari: Cuningham dkk, 2001
The use of PARTOGRAM

CPD head or abdominal
circumference of >35 cm;
Contracted pelvis (Ro or CT) -
incidence of 1%
Malpresentation - posterior occiput
Malposisi
Risk of laceration
U incision is the
best avoiding the
vessels
Hemostatic stitch
perpendicular to
the vessels
Dikutip dari: Cuningham dkk, 2001
Lebih baik dengan
cara avue : Gunting
arah keatas ! Bentuk
U
Hindari pelebaran
tumpul mencapai
vasa uterina
Dikutip dari: Cuningham dkk, 2001

Dikutip dari: Cuningham dkk, 2001
Severe Preeclampsia
FDJP /Biophysical profile < 6
CTG : Severe deceleration, non reactive
Thick meconium
Placental Insufficiency : Postterm > 42
mgg
Prolaps t.pusat
READY FOR RESCUCITATION
PROBLEM
laceration
hematoma
Bleeding from LS

Delivery of infant

placenta di depan
PREVENTION
Uincision
Hemostatic stitches
Stitches, tampon

forsep, vacuum,
extraction
insisi longitudinal
rdh
Robekan
Hematoma
Perdarahan dari insersi
Atonia
Kesulitan pengeluaran
kepala
Malposisi kepala
Dikutip dari:W.C. Wong et al 2001
Low longitudinal Incision
Indication :

preterm
Placenta previa in
anterior
Shoulder pres.

Emergency CS
INDIKASI: Keadaan
umum buruk, risiko
anestesi umm/regional
CARA: Infiltrasi
lidokain 0.5% ,
Atau: ketamin 50 mg
bolus + Tetes Ketamin
100 mg/500 RL
Spinal is the best
Antiseptic
Universal
precaution
Facilities, vital
monitoring
recording

Dikutip dari: E.J . Quilligan, 2001
Dikutip dari: E.J . Quilligan, 2001
Trends
Amerika berusaha
untuk mencapai
tingkat angka seksio
15%
Dikutip dari: Cuningham dkk, 2001
When is it safe for next
pregnancy ?
Risik of uterine rupture will increase if
interval is less than 18 months.
Evaluation of the thickness of low segmen
at term.
Rozenberg (1996): risk of uterine rupture
increase if < 3.5 mm sensitifity 88%,
specificity 99%.
VBAC
RATE
Rebound effect
Due to rate of CS
VBAC

Dikutip dari: Cuningham dkk, 2001
Contraindication for VBAC
Contracted pelvis
Macrosomia
Classic incision or deep myomectomy
Overdistended
Readiness for emergency CS (?)
Dikutip dari: E.J . Quilligan, 2001

Dikutip dari: Cuningham dkk, 2001

Dikutip dari: Cuningham dkk, 2001
INFORMED
CONSENT
Information on indication, risk
and benefit
AUDIT
Regular Maternal Perinatal meeting
(weekly/monthly)
Review for indications (e.g fetal distress)
Morbidity
Guidelines (EFM)
May reduce the rate
Report and dissemination

Model sistem skoring
0 1 prediksi keberhasilan P4S adalah
16% - 33%
2 3 prediksi keberhasilan P4S adalah
54% - 82%
4 5 prediksi keberhasilan P4S adalah
92% - 96%